Community Care of Brooklyn Independent Practice Association has become a state Department of Health-certified accountable care organization.

The Centers for Medicare and Medicaid Services has also approved the ACO to participate in its Medicare Shared Savings Program.

The designation marks the latest value-based payment program the association has entered into with the goal of continuing partnerships, investments and improvements in population health, which began under the Delivery System Reform Incentive Payment program. It further positions the group to continue efforts in Brooklyn with or without DSRIP, which is scheduled to come to an end next year unless it's renewed.

As an accountable care organization, the association will work to reduce unnecessary spending and improve quality of care for Medicare fee-for-service beneficiaries receiving services at one of 65 participating sites, including hospitals, ambulatory care programs, private practices, federally qualified health centers and behavioral health clinics.

The designation will help the association expand the reach of its DSRIP initiatives and design Medicare-specific resources. It also will provide it with opportunities to earn shared savings that can be reinvested in infrastructure and care processes and distributed among participating providers.

The designation follows the association's establishment last year to continue the progress made by Community Care of Brooklyn Performing Provider System, which is led by Maimonides Medical Center in the DSRIP program. As a separate legal entity, the association can enter into contracts on behalf of its network.

Securing the designation has been contemplated since the beginning of the DSRIP program, said Dr. David Cohen, executive vice president and chair of population health at Maimonides as well as chair of Community Care of Brooklyn and a board member of the association. The program is meant not only to encourage delivery system reform but also payment reform, with a focus on moving into value-based payment agreements to achieve higher quality care at a lower cost.

"It really is about defining a network, helping that network work closely together and providing all of the supports that are needed for the patients and providers to make sure people get the most effective and efficient care," Cohen said. "That's the goal of the DSRIP program, and that is the goal of an ACO."

A focus on Medicare patients, who many times become more vulnerable as they age, was important as well.

"Any transformation effort must include a focus on Medicaid to be successful in Brooklyn, however CCB IPA's mission is to improve the health of all Brooklyn residents, regardless of insurance coverage," said LaRay Brown, chair of the association's board of directors, CEO of One Brooklyn Health System, and president and CEO of Interfaith Medical Center, in a statement. "While we are hopeful that the DSRIP program will continue, we are working now to sustain the relationships and significant progress made over the last five years and are excited to expand the reach of our work to the Medicare population as an ACO."

Other association priorities include the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement Advanced Initiative at six Brooklyn hospitals as well as oversight of five value-based payment arrangements with Medicaid managed-care organizations.

There are more than 50,000 patients engaged in the association's value-based payment initiatives. That number is expected to grow with the ACO designation. —Jennifer Henderson

Mr. Rivera goes to Toronto

State Sen. Gustavo Rivera, chairman of the Senate's health committee, led a delegation to Toronto on a fact-finding mission last week to learn more about Canada's single-payer health system and supervised-injection facilities—two policy issues that the Bronx senator has pursued through legislation.

Rivera has sponsored the New York Health Act, which would create a single-payer fund to cover medical services, drugs and long-term care for all New Yorkers without requiring out-of-pocket payments. He also has sponsored the Overdose Prevention Centers Act, which would allow for certain counties to test facilities where people could inject drugs under medical supervision. The goal is to reduce overdose deaths.

"It convinced me further that whether we're talking about pursuing single-payer or overdose prevention centers, these are policies worth fighting for," he said in an interview.

Rivera—along with Democratic colleagues Pete Harckham, Roxanne Persaud and Diane Savino and Republican Sen. Patrick Gallivan—toured St. Michael's Hospital and a supervised-injection facility in Toronto. The trip came after stops at health facilities in Buffalo and rural upstate counties.

Rivera said the Toronto supervised-injection facility looked like a doctor's office where clean drug paraphernalia is available for users.

At one of the facilities Rivera visited, neighbors supported maintaining the program after local politicians considered removing it, he said.

Gaining that kind of community buy-in is likely to be important if New York does proceed with a pilot program.

Mayor Bill de Blasio proposed a four-site pilot last year, but so far the project has not received state approval. The federal government, which has threatened to intervene, sued a nonprofit in Philadelphia to stop such an opening in that city.

"I've said, If you don't want it in your backyard, I want it in mine, because I want my neighbors to be alive tomorrow," Rivera said. "We need bold action now." —Jonathan LaMantia

Montefiore operating profit drops by half through June

Montefiore Health System earned $22 million in operating income in the first half of the year—less than half of the $48.6 million it reported in the same period in 2018, according to unaudited financial statements.

The 11-hospital system's operating margin was just 0.7%, down from nearly 1.7% in the first six months of 2018. A Montefiore spokeswoman attributed the declining margin to low reimbursement from Medicare and Medicaid, which insure 85% of its patients. The median operating margin at U.S. nonprofit and public hospitals last year was 1.7%, according to a survey by Moody's Investors Service.

The system increased operating revenue by 7.3%, to $3.1 billion, while operating expenses climbed 8.3%, to $3.1 billion, which it said was due to higher payment rates from insurers. Montefiore hospitals received $37.8 million in state safety-net programs, which pushed it into profitability.

After unrealized gains on its investments and additional grants, the health system earned $100.9 million in net income in the first half of the year, which was 8.5% higher than the comparable figure in 2018.

Volume at its hospitals was down in the first half, but there wasn't a noticeable improvement in primary care visits. The system said outpatient visits in specialties such as cardiology, neurosurgery and orthopedic surgery increased.

Montefiore reported utilization statistics only for its Bronx hospitals, which showed a 2.9% decline in discharges, to about 44,000, through the end of June. ER visits dropped 1.5%, to around 126,000. Its medical group's number of primary care visits fell 0.2%, to 404,000. Outpatient revenue increased 9.7%.

"Hospital admissions decreased, while outpatient volume continues to rise, reflective of our efforts to transform care delivery to occur where, when and how people need it the most," the Montefiore spokeswoman said. —J.L.

Jewish Board launches psychiatric nurse residency program

The Jewish Board of Family and Children's Services has launched a psychiatric nurse practitioner residency program.

The program is designed to help recently graduated psychiatric nurse practitioners obtain additional training in psychiatry and mental health and address a shortage of psychiatric nurse practitioners in New York, the organization said.

The one-year curriculum is similar to a medical school residency model. It starts in September, ends the following August and offers intensive training and supervision by experienced psychiatric nurse practitioners at the Jewish Board.

"The Jewish Board is a nonprofit mental health care provider, so we're especially impacted by the dynamic financial challenges of the health care field, especially in recruiting psychiatric nurse practitioners and psychiatrists," said Tim O'Connor, psychiatric nurse practitioner and director of the new program, in a statement provided to Crain's. "Our residency program allows us to better attract, train and retain newly graduated PNPs, who are a rapidly growing part of the psychiatric prescriber workforce at the Jewish Board, in New York and beyond."

The Jewish Board provides community-based services at more than 50 mental health centers, including satellite clinics in schools, among other locations. It has an annual budget of about $250 million and provides services to more than 40,000 individuals a year. —J.H.

AT A GLANCE

AD CAMPAIGN: Healthfirst is launching an advertising campaign, including TV, outdoor, print, social and digital ads. The theme of the campaign, "Healthfirst is keeping care in your health care." It will include a sponsorship as the wellness partner of the New York Mets through 2021, with ads in-stadium on the radio and during SNY broadcasts. It will also incorporate the campaign on Citi Bike docks, particularly ones near NYCHA housing. The insurer declined to disclose the cost of the campaign.

JAMES BALKS AT PURDUE DEAL: State Attorney General Letitia James is one of several attorneys general who have pushed back against a potential $10 billion to $12 billion settlement with opioid maker Purdue Pharma, The Wall Street Journal reported. One of their concerns is the settlement's reliance on future sales on drugs that have proven destructive to communities.

HEALTH CARE DEALS: The health care industry has avoided a summer deal slump amid a boost in the number of transactions announced or closed in July, Bloomberg Law reported, citing a list of deals prepared for it by investment bankers at ECG Management Consultants and Provident Healthcare Partners. Physician practices and services was the top sector for transactions, with 31 last month.

CUDDLERS WANTED: The UNC-Rex Birth Center neonatal intensive care unit in Raleigh, N.C. is looking for more volunteers to snuggle newborns, with the program aimed at boosting brain development and lessening lengths of stay, CNN reported.

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